Soft tissue repair assembly and associated method

ABSTRACT

A soft tissue repair assembly. The assembly includes a flexible member having first and second ends, and a strand passing through the flexible member. The strand has first and second strand ends extending through the flexible member, such that pulling at least one of the first and second strand ends changes the flexible member from a first shape suitable for insertion through soft tissue to a second shape suitable for securely lodging the soft tissue repair assembly relative to soft tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 13/767,401, filed on Feb. 14, 2013, now issued as U.S. Pat. No. 9,414,833, which is a continuation of U.S. patent application Ser. No. 12/828,977 filed on Jul. 1, 2010, now issued as U.S. Pat. No. 8,409,253, which is a divisional of U.S. patent application Ser. No. 11/347,661 filed on Feb. 3, 2006, now U.S. Pat. No. 7,749,250 issued on Jul. 6, 2010. The entire disclosure of the above identified application is incorporated herein by reference.

INTRODUCTION

Tears caused by trauma or disease in soft tissue, such as cartilage, ligament, or muscle, can be repaired by suturing. Various assemblies have been developed for facilitating suturing and are effective for their intended purposes. Nevertheless, tissue repair assemblies for facilitating suturing are still desirable.

SUMMARY

The present teachings provide a soft tissue repair assembly. The assembly includes a flexible member having first and second ends, and a flexible strand passing through the flexible member. The strand has first and second strand ends extending through the flexible member, such that pulling at least one of the first and second strand ends changes the flexible member from a first shape suitable for insertion through soft tissue to a second shape suitable for securely lodging the soft tissue repair assembly relative to soft tissue.

The present teachings provide a soft tissue repair assembly that includes an inserter, at least one flexible member preloaded on the inserter in a first shape, and a flexible strand coupled to the flexible member for changing the shape of the flexible member from the first shape to a second shape after implantation, wherein the second shape is suitable for securely lodging the flexible member relative to soft tissue.

The present teachings provide a method for repairing a tear in soft tissue. The method includes preloading a flexible member coupled to a flexible strand on an inserter, inserting the inserter through tissue from a first side of the tear to a second side of the tear, and deploying the flexible member relative to the soft tissue. The method further includes tensioning the strand, changing the shape of the flexible member from a first shape to a second shape suitable for securely lodging the flexible member relative to the soft tissue, and reducing or closing the tear.

The present teachings provide a method for repairing a tear in a meniscus during arthroscopic knee procedure. The method includes inserting an inserter through the tear to an outer surface of the meniscus, deploying a first flexible member coupled to a flexible strand from the inserter on an outer surface of the meniscus, tensioning the strand, changing the shape of the first flexible member from a first shape to a second shape for securing the flexible member on the outer surface, and reducing or closing the tear.

Further areas of applicability of the present invention will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from the detailed description and the accompanying drawings, wherein:

FIG. 1 is an exploded view of a soft-tissue repair assembly according to the present teachings;

FIG. 2 is a perspective view of a soft-tissue repair assembly according to the present teachings, shown in a first shape;

FIG. 3 is a perspective view of the soft-tissue repair assembly of FIG. 2 , shown in a second shape;

FIG. 4 is an environmental view of the soft-tissue repair assembly of FIG. 2 , shown implanted relative to soft tissue;

FIG. 5 is a perspective view of a plurality of connected soft-tissue repair assemblies according to the present teachings shown in first shapes;

FIG. 6 is an environmental view of the soft-tissue repair assemblies of FIG. 5 , shown in second shapes and implanted relative to soft tissue;

FIG. 7A is a plan view of a soft-tissue repair assembly according to the present teachings, shown in a first shape;

FIG. 7B is a plan view of the soft-tissue repair assembly of FIG. 7A, shown in a second shape;

FIG. 7C is a plan view of a soft-tissue repair assembly according to the present teachings, shown in a first shape;

FIG. 7D is a plan view of the soft-tissue repair assembly of FIG. 7C, shown in a second shape;

FIG. 7E is a plan view of a soft-tissue repair assembly according to the present teachings, shown in a first shape;

FIG. 7F is a plan view of the soft-tissue repair assembly of FIG. 7A, shown in a second shape;

FIG. 7G is a plan view of a soft-tissue repair assembly according to the present teachings;

FIG. 7H is a plan view of a soft-tissue repair assembly according to the present teachings, shown in a first shape;

FIG. 7I is a plan view of the soft-tissue repair assembly of FIG. 7H, shown in a second shape;

FIG. 7J is a plan view of a soft-tissue repair assembly according to the present teachings;

FIG. 7K is a plan view of a soft-tissue repair assembly according to the present teachings;

FIG. 8A is a plan view of an inserter according to the present teachings;

FIG. 8B is a side view of the inserter of FIG. 8A;

FIG. 9A is a plan view of an inserter according to the present teachings;

FIG. 9B is a side view of the inserter of FIG. 9A;

FIG. 10 is a side view of an inserter shown holding a soft-tissue repair assembly according to the present teachings;

FIG. 10A is a perspective view of an exemplary inserter, according to the present teachings;

FIG. 11 is a side view of an inserter shown holding two soft-tissue repair assemblies according to the present teachings;

FIG. 11A is a side view of an inserter shown holding two soft-tissue repair assemblies according to the present teachings;

FIG. 12 is a side view of an inserter shown holding a soft-tissue repair assembly according to the present teachings;

FIG. 13 is a side view of an inserter shown holding a soft-tissue repair assembly according to the present teachings;

FIG. 14 is a plan view of an inserter shown holding a soft-tissue repair assembly according to the present teachings;

FIG. 15 is a plan view of an inserter shown holding a soft-tissue repair assembly according to the present teachings;

FIG. 16 is a perspective view of a soft-tissue repair assembly according to the present teachings;

FIG. 17 is a perspective view of a soft-tissue repair assembly according to the present teachings;

FIG. 18 is a perspective view of a soft-tissue repair assembly according to the present teachings;

FIG. 19 is an environmental view of a soft-tissue repair assembly according to the present teachings; and

FIG. 20 is an environmental view of a soft-tissue repair assembly according to the present teachings.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is in no way intended to limit the invention, its application, or uses. For example, although the present teachings are illustrated in an application for meniscus repair in knee surgery, the present teachings can also be used for repairing any tissue, such as bone, muscle, ligament or tendon in an arthroscopic or other open procedure.

Referring to FIG. 1 and FIG. 7E, an exemplary soft tissue repair assembly 100 according to the present teachings can include a flexible member 102, and a flexible strand 103, such as, for example, thread, ligament, wire, or suture. The strand 103 can be coupled with the flexible member 102 for changing the shape of the flexible member 102. The flexible member 102 can be an elongated member having first and second ends 107, 109. The elongated member can include a substantially cylindrical wall 111 having a longitudinal bore 105, as illustrated in FIG. 1 , or can be a flexible elongated solid member 102 with a bore, as illustrated in FIG. 7E, or any other shape. The flexible member 102 can be made of resorbable or non-resorbable materials, including sponges and sponge-like materials in solid form, perforated materials, woven/braided from biocompatible materials or fibers, such as, for example, polymer, polyester, polyethylene, cotton, silk, or other natural or synthetic materials, include sponges and sponge-like materials. The flexible member 102 can also be an elongated tubular or solid member or a two-dimensional member with or without internal bores. The flexible member 102 can have any properties that allow the flexible member 102 to change shape. The flexible member 102 can be, for example, compliant, flexible, foldable, squashable, squeezable, deformable, limp, flaccid, elastic, low-modulus, soft, spongy, perforated or any other flexible member which can change shape. In some aspects, the flexible member 102 can be coated with biological or biocompatible coatings, and it can also be soaked in platelets and other biologics, which can be easily absorbed by the flexible member 102 in particular when, for example, the flexible member 102 is made from spongy, absorbent material.

Referring to FIGS. 1-4 , the flexible strand 103 can include an inner loop portion 104 and outer strand portion 106. The inner loop portion 104 can be substantially contained within the bore 105, such that the inner loop portion 104 extends from the first end 107 of the bore 105, passes through the bore 105, and terminates at the second end 109 of the bore 105. The outer strand portion 106 can be coupled to the loop portion 104 adjacent the first and second ends 107, 109 and can extend substantially outside the flexible member 102.

The strand 103 can be made of braided filaments or fibers of biocompatible material, including natural and synthetic fibers, such as cotton, silk, polymer, polyester, polyethylene, and other materials. The inner loop portion 104 can be knotted, as shown in FIG. 1 , or continuous, as shown in FIG. 2 . The outer strand portion 106 can be a separate piece of strand 103 and can include first and second ends 106 a, 106 b. Pulling at the ends 106 a, 106 b, or at least one of the ends 106 a, 106 b while holding the other end fixed, when the flexible member 102 is implanted relative to soft tissue or on an outer surface of soft tissue causes the flexible member 102 to change shape from a first shape to a second or implanted shape. The first shape of the flexible member 102 can be a thin elongated shape with length to width (aspect ratio) greater than one. The first shape of the flexible member 102 can also be a folded shape. The implanted shape of the flexible member 102 can be a bulkier shape with length to width ratio close to one, as illustrated in FIGS. 3 and 4 , for snugly securing the flexible member 102 relative to or on an outer surface of soft tissue 80. The implanted shape of the flexible member 102 can have bigger overall width or enclosed cross-sectional area or volume than those of the first shape such that the flexible member 102 cannot be pulled out of the same opening through which it was originally inserted. In one aspect, the flexible member 102 can retain its bulkier shape after implantation, even after the tension on the strand portion 106 is removed.

In the exemplary illustration of FIG. 4 , the soft-tissue repair assembly 100 is shown implanted on an outer surface 84, such as a posterior surface of a meniscal soft tissue 80, after passing through a tear 82 for reducing or closing the tear 82. In FIG. 4 , the suture securing second shape of the flexible member 102 is substantially a circular shape, but having a slit or gap 101. Referring to FIGS. 5 and 6 , multiple soft tissue repair assemblies 100 can be daisy-chained together by a single continuous outer strand portion 106 connected to each inner loop portion 104 for reducing the tear 82. Generally, the soft-tissue repair assembly 100 can be positioned relative to soft tissue, such as in the soft tissue, adjacent the soft tissue, or on an outer surface of the soft tissue.

Referring to FIG. 7A, a continuous strand 110 can be used to define an inner loop having an outer portion and loop ends 110 a, 110 b. After the strand 110 is looped around the bore 105 of the flexible member 102, such that the first and second ends 107, 109 of the flexible member 102 are coupled by the outer portion of the strand 110, the loop ends 110 a, 110 b of the continuous strand 110 exit the bore 105 through small wall openings 108 a, 108 b adjacent but displaced from the ends 107, 109 of the flexible member 102. A second strand 106 having ends 106 a, 106 b is looped around the loop ends 110 a, 110 b. Pulling the ends 106 a, 106 b, of the second strand 106 causes the flexible member 102 to change shape to an eight-like securing shape, which appears pinched in the vicinity of the openings 108 a, 108 b, as illustrated in FIG. 7B. The eight-like shape of the flexible member 102 provides a geometry that encloses bigger area or volume for the same length of flexible member. Bigger securing volume can prevent the flexible member 102 from being pulled out of the insertion opening, and can provide secure and strong anchoring in various applications at the discretion of the surgeon.

Referring to FIGS. 7C and 7D, a continuous strand 110 can be passed through the bore 105 of the flexible member 102, such the strand ends 110 a, 110 b exit through wall openings 113 defined away from the flexible member ends 107, 109, in a middle section of the flexible member 102, such that pulling the strand ends 110 a, 110 b away from the flexible member 102, causes the flexible member 102 to change shape into a pretzel-like securing shape, which can be selected for application when bigger enclosed area/volume is desired for the same length of flexible member 102. It will be appreciated that the wall openings 113, as well as the wall openings 108 a, 108 b discussed above in connection with FIGS. 7A, 7B, do not need to be preformed holes. The wall openings 113, 108 a, 108 b, can be for example, space between fibers when the flexible member is woven or braided. The strand 110 can be passed through the wall 111 or between woven/braided fibers of the flexible member 102 using a suture threader, for example, or other instrument. The wall openings 108 a, 108 b and 113 can allow the flexible member 102 to slide relatively freely along at least a portion of the strand 110, thereby helping to position the strand 110 before changing the shape of the flexible member 102 to the final implantation and suture securing shape.

It will be appreciated that various soft-tissue suture securing shapes, including those described above as well as other shapes, can be used with the same flexible member 102 by varying the manner of looping the strand or strand portions or separate strands relative to the flexible member 102, and varying the number and/or location of various openings, such as the openings 108 a, 108 b, 113 described above, for producing a desired suture-securing shape. Generally, the suture-securing shapes have a bulky shape and occupy a greater volume for securing the flexible member 102 snuggly into soft tissue. Furthermore, the flexible member 102 lacks any sharp or cutting elements, sharp points, edges, or planes, such as barbs, hooks, fins, pins, threads, ribs, or other tissue-piercing features, generally associated sharp-element anchoring. Accordingly, the soft tissue repair assembly 102, in its various shapes, does not pierce or cut or otherwise injure soft tissue, and does not rely on sharp-element anchoring for securing suture into soft tissue. On the contrary, the soft-tissue repair assembly 100 provides suture securing that can be effected by changing the shape of the flexible member 102 into a bulkier second shape, which is relatively smooth and lacks any sharp elements or geometric features. In the bulkier shape the flexible member 102 can be lodged tightly outside soft tissue, or in or between layers of soft tissue, possibly displacing soft tissue, but without piercing, cutting or otherwise damaging soft tissue. In the bulkier shape, the flexible member 102 can be prevented from backing out of the original insertion opening, or tearing through tissue.

Referring to FIGS. 7E-7G, the elongated flexible member 102 can be coupled with a flexible strand 103 which can be retained with a button or knot or other retainer 140 adjacent a first end 107 of the flexible member 102 and then threaded in and out of the flexible member 102 along a longitudinal axis A of the flexible member 102 exiting adjacent a second end 109 of the flexible member 102. Pulling the strand 103 away from the retainer 140 can cause the flexible member 102 to scrunch up against the retainer 140 in a wavy, zigzag, multifold or accordion-like fashion, as illustrated in FIGS. 7F and 7G. The flexile member 102 can have a solid or annular cross-section.

Referring to FIGS. 7H-7K, the flexible member 102 can have a substantially flat, planar or generally two-dimensional shape, formed, for example, as a flat sponge or a piece of woven fabric or other flaccid material which can be pierced for passing a single strand 110 therethrough, as illustrated in FIG. 7J, or for passing a strand loop 104 coupled with an open strand 106, as illustrated in FIG. 7H. A piece of strand 103 can be passed through the flexible member 102 in various other configurations, including, for example, the configuration illustrated in FIG. 9K. Pulling at least one the strand 103, 106, 110 can cause the flexible member 102 to change shape. FIG. 7I, for example, illustrates the new shape of the flexible member 102 of FIG. 7H, after tensioning the strand 106.

Referring to FIGS. 8A-15 , various instruments can be used for implanting one or more soft tissue assemblies 100 relative to soft tissue. FIGS. 8A, 8B and 14 illustrate an inserter 120 having a rounded angled tip surface 124 and a shaft 121 defining a cutout or groove 122. The groove 122 can be configured for supporting a single flexible member 102 in a bent or folded shape draped over the groove 122, as illustrated in FIG. 14 . FIGS. 9A, 9B and 15 , illustrate a similar inserter 120 having a substantially rectangular angled tip surface 124. A sleeve 125 can be placed over the flexible member 102 to protect and keep the flexible member 102 and the strand 106 on the inserter 120, as illustrated in FIG. 15 .

Referring to FIGS. 10, 10A, 11 and 11A, one or more soft tissue assemblies 100 can be preloaded in a tubular inserter 130, such as the exemplary inserter 130 illustrated in FIG. 10A. The inserter 130 can include a handle 145 with a slider 137 and a shaft carrying a needle 139 having a bore 132. The flexible members 102 of the soft tissue assemblies 100 can be pushed out of the bore 132 using a plunger, a flexible pusher, such as a nitinol pusher, or other similar tool 131 operated by the slider 137. Referring to FIG. 11A, in an exemplary aspect two flexible members 102 are shown preloaded in the bore 132 of the needle 139 ahead of a stop 133. The flexible members 102 can be coupled by a strand 106 with a pre-knotted slip knot as discussed above, and can be separated by a curved end 141 of the flexible pusher 131. The curved end 141 of the flexible pusher 131 can push the first flexible member 102 out of the needle 139. The curved end 141 of the flexible pusher 131 can be straightened out as the flexible pusher 131 is retracted under the second flexible member 102, and positioned ahead of the stop 133 for pushing the second flexible member 102 out of the needle 139. Referring to FIG. 12 , in another aspect, a single soft tissue assembly 100 can be loaded on a fork of a forked inserter 136.

In an exemplary soft tissue repair procedure, such as repair of a meniscal tear 82, one of the inserters 120, 130, 136, pre-loaded with at least one soft tissue repair assembly 100, can be inserted through a knee incision and through the meniscal tear 82. The flexible member 102 with the strand 106 coupled thereto can be implanted past the tear 82 on the posterior or outer surface 84 of the meniscal soft tissue 80, as illustrated, for example, in FIG. 4 . The inserter 120, 130, 136 can then be removed leaving the strand ends 106 a, 106 b extending through the tear 82. Pulling the strand ends 106 a, 106 b away from the tear 82, causes the flexible member 102 to change shape into a suture securing shape, as discussed above, securely lodged on the outer surface soft tissue, without piercing, cutting or otherwise damaging tissue. The pulling action of the strand 106 reduces or closes the opening of the tear 82. Multiple soft-tissue repair assemblies 100 can be similarly implanted in daisy-chain fashion, as illustrated in FIG. 6 , using the tubular inserter 130 with the multiple repair assemblies pre-loaded therein, or one by one, disconnectedly. Similar implanting procedures can be used for the soft-tissue repair assemblies 100 illustrated in FIGS. 7A, 7C, 7E, 7G, 7H, 7I and 7K. After implantation, the strand ends 106 a, 106 b or 110 a, 110 b can be secured with a knot, such as, for example, a pre-tied, self-locking slip knot, or other knot, and optionally with the help of a retainer, such as a retaining button, anchor, or other auxiliary retaining device (not shown).

During insertion and before implantation, the flexible member 102 can be supported and maintained in the bore 132 of the tubular inserter 130 in a linear shape, as illustrated in FIGS. 10, 11 and 11A. After deployment from the tubular inserter 130 for implantation relative to tissue, the flexible member 102 can change shape from a first shape into a second securing shape of curvilinear profile by tensioning the strand 106. In another aspect, the flexible member 102 can be supported or draped on the grooved inserter 120 or on the forked inserter 136 in a substantially folded or U-shape, as illustrated in FIGS. 14, 15 and 12 . After deployment from the grooved inserter 120 or the forked inserter 136 for implantation relative to tissue, the flexible member 102 can be changed into a securing shape of curvilinear profile by tensioning the strand 106, as described above. It is noted that the substantially folded or U-shape, which is used with the grooved inserter 120 or the forked inserter 136 for loading the flexible member 102, is an intermediate shape between the first linear shape, and the securing shape of curvilinear profile that provides a bulky shape for securely lodging the flexible member 102 into tissue.

In another aspect, and referring to FIGS. 16-20 , a soft-tissue repair assembly 100 can include one or more linear pipettes or pipette segments 150 over a strand 154 that can be used to reduce or close the tear 82. The repair-promoting pipette 150 can be made of resorbable or non-resorbable polymeric materials, collagen, allograft, such as segments of arteries or veins, or other solid-wall or woven/braided porous materials. The pipette 150 can also include perforations 162 for promoting additional biological flow. The strand 154 can pass through the tear 82 for reducing the opening of the tear 82, and can be secured with a knot 156. The soft-tissue repair assembly 100 can include one or more soft-tissue repair-promoting small tubes or pipettes 150, which can create conduits for vascularization and/or flow of nutrients, blood and other biological fluids and substances.

Referring to FIG. 16 , for example, the strand 154 can enter and pass through a first pipette 150 in one direction, pass through strand loop 104 of a first flexible member 102, pass through the first pipette 150 in the opposite direction and exit the first pipette 150, and similarly pass through the second pipette 150, the second flexible member 102, and out of the second pipette 150, as illustrated by the directional arrows along the strand 154.

Referring to FIG. 17 , a single U-shaped pipette 150 can be used to run along the strand 154 between two flexible members 102. The strand ends 154 a, 154 b can exit the pipette 152 through small openings 153 at the bottom of the “U”. The U-shape can be provided by using an originally straight, but flexible/compliant pipette 150 that changes shape while following the U-shaped portion of the strand 154 between the two flexible members 102, or by providing an originally curved pipette 150.

Referring to FIGS. 18 and 20 , a single pipette 150 can be used with one flexible member 102, with the strand 154 entering and exiting the pipette 150 in opposite directions before and after passing through the suture loop 104 of the flexible member 102. The flexible member 102 can be optionally used, or can be omitted entirely, as indicated by phantom lines in FIG. 20 . Referring to FIG. 19 , two pipettes 150 can be used over corresponding portions of the suture 154, with or without the use of flexible members 102. Additionally, one or more pipettes 150 can be used independently without any suture or strand 154 passing therethrough for promoting vascularization and healing.

Referring to FIGS. 4 and 6 , the tissue repair assembly 100 can be used, for example, for implanting one flexible member 102, or multiple flexible members 102 for meniscal repair in an arthroscopic knee procedure. Referring to FIG. 4 an exemplary repair using a single flexible member 102 is illustrated. The flexible member 102 can be implanted using one of the inserters 120, 130, 136 discussed above and illustrated in FIGS. 8-15 . The inserter 120, 130, 136 can inserted, with the flexible member 102 pre-loaded in a first shape, as discussed above, into meniscal tissue 80 through the meniscal tear 82. The flexible member 102 can be deployed from the inserter 120, 130, 136 by manual means or pushing the plunger 131 or other deploying device, and implanted on the posterior or outer surface 84 of the meniscal tissue 80 of the knee. The inserter 120, 130, 136 can be then withdrawn. At least one of ends 106 a, 106 b of the strand 106 can be pulled, causing the flexible member 102 to change to a second shape, as described above in connection with FIGS. 3, 4, 4A-7D. The thus-shaped flexible member 102 provides resistance against the outer meniscal surface 84, such that further tensioning the strand 106, causes the tear 82 to be reduced or closed. A slip knot, similar to the knot 156 illustrated in FIG. 20 , and or another retaining device, such as a soft tissue anchor can be used to secure the strand 106 or the ends 106 a, 106 b to tissue.

Referring to FIGS. 6, 11, and 11A, the tubular inserter 130 can be used to implant multiple flexible members 102 on the posterior or other outer surface 84 of the meniscal tissue 80. The tubular inserter 130 can pre-loaded with multiple flexible members 102, which assume a first shape during loading and insertion, and which are coupled therebetween by the strand 106. After the first flexible member 102 is deployed from the inserter 130, as described above, in a first position on the outer surface 84, the inserter 130 can be withdrawn, re-inserted through the meniscal tear 82 and used to deploy a second flexible member 102 at a second position spaced apart from the first flexible member 102. After the last flexible member 102 is similarly deployed, the inserter 130 can be withdrawn, and the strand 106 tensioned by pulling one or both ends away from the tear 82, as illustrated in FIG. 6 . Tensioning the strand 106 causes each of the flexible members 102 change to a second shape, thereby resisting further tensioning and causing the tear 82 to be reduced or closed.

The tubular inserter 130 can be similarly used to deploy one or more pipettes 150 independently, or with strands 154 and with or without one or more flexible members 102 for the configurations illustrated in FIGS. 16-20 .

It will be appreciated that the soft-tissue repair assembly 100 of the present teachings provides an economically efficient, effective and versatile device for securing suture relative to soft tissue and repairing associated tears. Furthermore, the soft-tissue repair assembly 100 avoids or reduces tissue damage and relies on its rounded second shape for snug securing into tissue after implantation. Implantation can be facilitated by using an inserter according to the present teachings, and providing one or more flexible members 102 and connecting suture pre-loaded thereon. The new tissue repair techniques associated with the tissue repair assembly of the present teachings rely on existing surgeon skills and can be easily mastered.

The foregoing discussion discloses and describes merely exemplary arrangements of the present invention. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the invention as defined in the following claims. 

What is claimed is:
 1. A bone implant apparatus, comprising: an elongated tubular bone implant that includes a first end and a second end; a first anchoring element situated proximate the first end of the elongated tubular bone implant; a second anchoring element situated proximate the second end of the elongated tubular bone implant; and a suture assembly coupled to the first anchoring element and the second anchoring element and extending longitudinally through the elongated tubular bone implant between the first anchoring element and the second anchoring element, the suture assembly including a first free end that is located outside the elongated tubular bone implant via a portion of the suture assembly passing through a side wall opening in the elongated tubular bone implant, the side wall opening positioned between the first end of the elongated tubular bone implant and the second end of the elongated tubular bone implant, wherein the first free end of the suture assembly can be pulled to tension the suture assembly between the first anchoring element and the second anchoring element, wherein, along a first length of the suture assembly that extends from the first free end of the suture assembly to the portion of the suture assembly passing through the side wall opening in the elongated tubular bone implant, the entirety of said first length is located outside the elongated tubular bone implant without extending through the first anchoring element or the second anchoring element, wherein the first anchoring element is positionable away from the first end of the elongated tubular bone implant and the second anchoring element is positionable away from the second end of the elongated tubular bone implant, and wherein the first free end of the suture assembly is pullable to draw the first anchoring element toward the first end of the elongated tubular bone implant and draw the second anchoring element toward the second end of the elongated tubular bone implant.
 2. The bone implant apparatus of claim 1, wherein the suture assembly extends through the first end of the elongated tubular bone implant and through the second end of the elongated tubular bone implant.
 3. The bone implant apparatus of claim 1, wherein the suture assembly includes a suture loop formed using a self-locking slip knot.
 4. The bone implant apparatus of claim 1, wherein the suture assembly comprises a tensionable suture loop that includes a first loop portion extending through the first anchoring element to couple the tensionable suture loop to the first anchoring element and a second loop portion extending through the second anchoring element to couple the tensionable suture loop to the second anchoring element.
 5. The bone implant apparatus of claim 1, wherein the suture assembly comprises a tensionable suture loop, at least a portion of the tensionable suture loop extending longitudinally through the elongated tubular bone implant between the first anchoring element and the second anchoring element.
 6. The bone implant apparatus of claim 1, wherein the suture assembly includes a second length of suture extending longitudinally through the elongated tubular bone implant from the first anchoring element to the second anchoring element without passing through a side wall of the elongated tubular bone implant.
 7. A bone implant apparatus, comprising: an elongated tubular bone implant that includes a first end and a second end; a first anchoring element situated proximate the first end of the elongated tubular bone implant; a second anchoring element situated proximate the second end of the elongated tubular bone implant; and a suture assembly coupled to the first anchoring element and the second anchoring element and extending longitudinally through the elongated tubular bone implant between the first anchoring element and the second anchoring element, the suture assembly including a first free end that is located outside the elongated tubular bone implant via a portion of the suture assembly passing through a side wall opening in the elongated tubular bone implant, the side wall opening positioned between the first end of the elongated tubular bone implant and the second end of the elongated tubular bone implant, wherein the first free end of the suture assembly can be pulled to tension the suture assembly between the first anchoring element and the second anchoring element, wherein the suture assembly includes a length of suture extending longitudinally through the elongated tubular bone implant from the first anchoring element to the second anchoring element without passing through a side wall of the elongated tubular bone implant.
 8. The bone implant apparatus of claim 7, wherein the suture assembly comprises a tensionable suture loop that includes a first loop portion extending through the first anchoring element to couple the tensionable suture loop to the first anchoring element and a second loop portion extending through the second anchoring element to couple the tensionable suture loop to the second anchoring element.
 9. The bone implant apparatus of claim 7, wherein the first anchoring element is positioned away from the first end of the elongated tubular bone implant and the second anchoring element is positioned away from the second end of the elongated tubular bone implant, and wherein the first free end of the suture assembly is pullable to draw the first anchoring element toward the first end of the elongated tubular bone implant and draw the second anchoring element toward the second end of the elongated tubular bone implant.
 10. The bone implant apparatus of claim 7, wherein the suture assembly extends through the first end of the elongated tubular bone implant and through the second end of the elongated tubular bone implant.
 11. The bone implant apparatus of claim 7, wherein the suture assembly includes a suture loop formed using a self-locking slip knot.
 12. The bone implant apparatus of claim 7, wherein the suture assembly comprises a tensionable suture loop, at least a portion of the tensionable suture loop extending longitudinally through the elongated tubular bone implant between the first anchoring element and the second anchoring element.
 13. A bone implant apparatus, comprising: a first bone tissue anchor; a second bone tissue anchor; a tensioning suture coupled to and extending between the first hone tissue anchor and the second bone tissue anchor; and an elongated tubular implant slidably received on the tensioning suture between the first bone tissue anchor and the second bone tissue anchor, wherein the tensioning suture includes a first portion extending from inside the elongated tubular implant to outside the elongated tubular implant through a side wall opening in the elongated tubular implant, the side wall opening positioned between the first end of the elongated tubular implant and the second end of the elongated tubular implant, the first portion pullable to tension the tensioning suture between the first bone tissue anchor and the second bone tissue anchor wherein the tensioning suture includes a length of suture extending longitudinally through the elongated tubular implant from the first bone tissue anchor to the second bone tissue anchor without passing through a side wall of the elongated tubular implant.
 14. The bone implant apparatus of claim 13, wherein the first bone tissue anchor is positioned away from a first end of the elongated tubular implant and the second hone tissue anchor is positioned away from a second end of the elongated tubular implant, and wherein the first portion of the tensioning suture is pullable to draw the first bone tissue anchor toward the first end of the elongated tubular implant and draw the second bone tissue anchor toward the second end of the elongated tubular implant.
 15. The bone implant apparatus of claim 13, wherein the tensioning suture extends through a first open end of the elongated tubular implant, longitudinally through the elongated tubular implant, and through a second open end of the elongated tubular implant.
 16. The bone implant apparatus of claim 13, wherein the first portion of the tensioning suture includes a first free end located outside the elongated tubular implant.
 17. The bone implant apparatus of claim 16, wherein the first portion of the tensioning suture, after extending from inside the elongated tubular implant to outside the elongated tubular implant through the side wall opening in the elongated tubular implant, continues on to the first free end of the tensioning suture without passing back through the elongated tubular implant.
 18. The bone implant apparatus of claim 13, wherein the tensioning suture incorporates a slip knot for securing the bone implant apparatus.
 19. The bone implant apparatus of claim 13, wherein the tensioning suture incorporates a tensionable suture loop.
 20. The bone implant apparatus of claim 19, wherein the tensionable suture loop is formed using a pre-tied self-locking slip knot.
 21. The bone implant apparatus of claim 19, wherein at least a portion of the tensionable suture loop extends longitudinally through the elongated tubular implant between the first bone tissue anchor and the second bone tissue anchor.
 22. The bone implant apparatus of 13, wherein the tensioning suture comprises a tensionable suture loop that includes a first loop portion extending through the first bone tissue anchor to couple the tensionable suture loop to the first bone tissue anchor and a second loop portion extending through the second bone tissue anchor to couple the tensionable suture loop to the second bone tissue anchor. 